PDF Reducer Demo version

* S; ji6. i? J. I. Ti°>_P CHi Y HOC VI^T NAM T^P 459 • THANG 10 • SO 1 - 2017 alcoholic, and idiopathic pancreatitis in California, 1994-2001, Pancreas. 33:336. Muddana V, Whttcomb DC. Khalid A. Slivka A, Panachristou GI, Elevated serum creabnine as a marker of pancreatic necrosis in acute pancreatitis, Am J Gastroenterol 2009; 104(1): 164.. . Adam F l , . Bor C, Uyar M, Demirag K, ^nkayali 1. Severe acute pancreatitis admitted to intensive care unit: SOFA is superior to Ranson's criteria and APACHE II in determining prognosis.Turk J Gastroenterol, 2013;24(5):430-5.. SO NOAN TOI irU CHO KET QUA THU TINH TRONG ONG NGHIEM Nguyin XuSn Hoi*, Nguyin Thi Li8n HiroTig* TOM TAT Kich thfch buong tnirig nhim dat dUdc hieu qua toi •% UU va an toan la muc tieu quan trong ma cac chuyen .;. gia thu bnh trong ong nghiem hUdng tdi. Myc tieu: '.' Xac dinh so noan toi Uu ket qua thu tinh trong ong ; nghiem. Nghien euTu tien hanh tai benh vien Phu san •i Tmng uUng nam 2014. Thiet ke nghien ciiw. Nghien v. diu hoi CLTU, mo ta gom 2426 chu ky thu tinh ong ii nghiem (Khong bao gom cae chu ky dong phoi toan ji b6) chia lam 5 nhom dUa vao so noan thu dUctc sau choc hilt noan: Nhom 1: Khong c6 noan (4 chu ky); " Nh6m 2: 1-5 noan (478chu ky); Nhom 3: 6-10 noan ' (844chu ky); Nhom 4: 11-15 noan (802chu ky); Nhom :, S:>15 noan (498 ehu ky). Ket qua: Nhom 2 (1-5 •:• noan) eo so phoi tot, so ph6i chuyen trung binh, so ^, phoi chuyen tot trung binh, ty le co thai thap hdn co y „ nghTa thong ke so vdi nhom 3,4,5, Ty le co thai khong " Idiac biet giu^ 3 nhom 3,4,5. Ket luan: So noan toi •' du de dat ket qua eo thai tot tir 6-15 noan. I Tdkhoa: So noan toi uTj, ket qua thu tmh trong \\ ong nghiem. : SUIVIMARY OPTEMAL OOCYTES NUMBER FOR I N VITRO FERTIUZATION OUTCOI^E The implementation of safe and maximally i effective ovarian stimulation Is a major aim for in vitro , fertilization (IVF) teams. Objective: To investigate ' tiie optimal range number of oocyte retrieved for 'i achieving pregnancy in a in vitro fertilization in ART , center - National Hospital of Obstetrics and ' Gynecology from March to December 2014. Design: This is a retrospective, observational study. Materials and methods: 2426 IVF-ET cycles were included 5 groups of different oocye retrieved number: Group 1: r 0 oocyte (4 cycles); Group 2: 1-5 oocytes (478 P' cycles); Group 3: 6-10 oocytes (844 cycles); Group 4: !i 11-15 oocytes (802 cycles); Group 5: > 15 oocytes |i (498 cycles). Results:,Group 2 has the mean number !•' of embryos, mean number of transferred embryos, » mean number of good transferred embryos and. pregnancy rate signiUcant lower than group 3,4,5, The pregnancy rates were similar between 3 groups 3,4,5. Conclusion: The optimal number of oocytes for achieving the best chance of pregnancy rate is between 6-15 oocytes retrieved. Key words: IVF outcome, optimal range number of oocyte retrieved. I. OiiT VAN DE Nam 1978, em be thu bnh trong ong nghiem, Louise Brown, sinh ra sau mot ehu ky tu" nhien khong kich thich buong trirng. Sau do, de tang ty le CO thai eiia thu tinh trong ong nghiem, Kich thich buong triTng du'dc gidi thieu vao dau nam 1980 de cho phep thu du'dc nhieunoan va cd the lu'a chpn mot hoac nhieu phoi de chuyen phoi. Oe dat du'dc su" can bang giu'a viec thu du'dc qua it noan, lam giam cd hoi co thai, gay hau qua tieu cde cho benh nhan, nhieu nghien cu'u da du'dc thu'c hien nham tim ra so noan toi u'u hoa ket qua thu tlnh trong ong nghiem [1]. Tuy nhien, ket qua eae nghien ciTu eon nhieu mau thuan [2]. Nguyen nhan co the do phan ldn eac nghien ciTu khong kiem soat so lu'dng va chat lu'dng ciia phoi chuyen trong khi so lu'dng va chat lu'dng phoi chuyen cung tu'dng quan vdi so lu'dng noan. Nhieu noan hdn co the tang kha nang li/a chpn phoi tot de chuyen phoi. Viec bo qua thong tin ve phoi chuyen trong quan the nghien ciTu eo the dan den eac ket luan sai lech hoac giai thich sai, dan den eac quyet djnh thieu thong tin ve kich thich buong triTng va cac chien lu'dc chuyen phoi.ThiTc te lam sang cung eho thay, mot so nha chuyen mon thien ve ki'ch thi'eh buong triTng nhe de thu du'dc so noan viTa dii, mot so khac lai muon kich thich cang nhieu noan cang tot vi cho rang ed hpi co thai se cang cao.. Hien tai, chu'a co nghien ciTu nao trong nu'de vdi cd mau idn ve moi lien quan giij'a so noan f *Tnjng tam Ho trd sinh san Qudc Gia - Benh vien Phu thu du'dc sau choc hut den ket qua co thai trong \ san Trung t/dng. thu tlnh ong nghiem. Vi vay, nghien eiiu nay ciia fc Chiu trach nhiem chi'nh: Nguyen Xuan Hcfi chung toi du'dc thi/c hien trong thdi gian nam f Email: doctorhoi@gmail.eom 2014 tai trung tam Ho trd sinh san - Benh vien Ngay nhan bai: 5.7.2017 Phu san Trung U'dng, chia so noan sau choc hut I Ngay phan bien khoa hgc: 5.9.2017 lam nam nhom (0, 1-5, 6-10, 11-15, >15), vdi 8 Ngay duyet bai: 14.9.2017. VIETNAM MEDICAL JOURNAL N°1 - OCTOBER - 2017. muc tieu: Xac dinh sdnoan tdi Wu cho thg tlnh trong dng nghiem. Ket qua ciia nghien ciTu se gop phan quan trong trong viee tu' van, xac dinh lieu dung thuoc dieu tri cho cae cap vd chong thuC hien thu tinh trong ong nghiem nham dat du'dc k i t qua tot nhat, tranh ton kem va anh hu'dng den siTc khoe eua ngu'di phu nti'. II. €)6l TUQNG VA PHirONG PHAP NGHIEN CUU 1 . Dm tu'dng: Tat ca cae benh nhan thu'c hien thu tlnh trong ong nghiem tir thang 3 den th^ng 12 nam 2014 (n= 2426) day dii thong tin phuc vu nghien ciTu du'dc ehia iam 5 nhom du'a vao so noan thu du'dc sau chpc hitt noan; - Nhom 1: Khong c6 noan: n = 4. - Nhom 2: 1-5 noan: n = 478. - Nhom 3: 6-10 noan: n = 844. - Nhom 4: 11-15 noan: n = 802. - Nhom 5: >15 noan: n = 498. • Tieu chuan loai trir: Tat ca cac tru'dng hdp dong phoi toan bp, xin eho phoi, noan. 2. Phu'dng phap nghiin cu'u - Phac do thu tinh trong ong nghiim: Benh nhan du'dc kich thich buong triTng bang phac do dai, ngan Agonist hoac ngan Antagonist vdi lieu FSH khdi dau tiT ISOlO den 350IU/ ngay, du'dc theo doi bang sieu am va xet nghiem npl tiet. Khi cd it nhat 2 nang noan co kich thu'de Idn hdn 17mm hoac 1 nang tren 18mm, benh nhan se du'dc tiem kich thich phong noan iDang hCG lO.OOOiu. Chpc hut triTng sau hCG 35 - 37h. Thu tinh noan bang ky thuat bem tinh triing vao bao tu'dng noan. Phoi du'dc nuoi cay den ngay 3 thi tien hanh chuyen phoi tdd\. Tru'dng hdp eon du' phoi hoac khong co ehi djnh chuyen phoi tu'cfi, cac phoi tot se du'dc trii' lanh vao ngay 2 hoac ngay 3. - Cac tieu chuan danh gia du'dc suf dung trong nghien cu'u + Ph6i chat lu'dng tot: Phoi ngay 2 co 3-4 te. bao, bao tu'dng sang, b/ ie manh v9 < 25%, khong co phoi bao da nhan lioae eo khong bao.' -i-Co thai du'dc tinh khi 3hCG sau 14 ngay chuyen phoi > 25 lU/ml. ^— + Thai sinh hoa: du'dc tinh khi phCG ^ ^ ngay chuyen phoi > 25 lU/mi nhu'ng sieu aig chuyen phoi 4 tuan khong thay tui oi,^ buong tir cung. + Thai lam sang du'dc tinh khi sieu a m j CO tui 61 sau chuyen phoi 4 tuan. + Ty le CO thai: So ea chuyen phoi co^ tren tong so ea chuyen phoi. + Ty le CO thai lam sang: So ea co tui oitreti tong so ca eo phoi chuyen. + Ty ie lam to: So tui 61fren^ n g so phoi cfi^ Cae t / le du'dc tinh dda tren eae dmh nghia cua' Uy ban Qu6e te giam sat Ky thuat Ho trd sinhf (ICMART) va To ChiTc Y te The gidi (WHO) sig danh muc eac thuat ngu' ART, 2009 [3] 3. xiiT ly so lieu - Cae so lieu du'dc thu thap va xu" l y j ehu-dng trinh SPSS 20.0 - Tinh cac ty Ie, cac gia trj trung binh J bieu dien dudi dang Mean ± SD - Test y^de so sanh cac ty le, T test de so sanh cae gia tri trung binh, ty suat chenh OR [Q 95%) de danh gia cac nguy cd vdi p< 0.05 bieu thi sir khac biet co y nghTa thong ke. 4. Dao du'c nghien cuii - Nghien ciTu chi hoi CLTU tren benh an, khong can thiep tren ngu'di benh, khong iam sai ledi ket qua dieu tri eiia benh nhan. - Nghien cu'u chi vcfi muc dich phuc vu cham soc va bao ve su'c khoe nhan dan, khong nham muc dich nao khac. Dam bao quy dinh ve 3ao diJTc trong nghien ciTu y hpc ciia Bp da quy djnh, - Cac thong tin ve benh nhan se du'dc bao mat theo diing qui djnh eiia phap luat hien hanh.. III. KET QUA Bang 1. Dae diem mau nghien eiiij eiia nam nhdm noan khac nhau Nhoml Nhom 2 Nhom 3 Nhom 4 (11-15) (6-10) (0) (1-5) N 4 478 844 802 31,2 ± 30,3± 34,9 ± 32,8 ± Tuoi 5,6 5,3 4,7 5,1 AMH trung binh 4,5 ± 3,2 2,3 ± 2,0 5,8 ± 3,7 4,1 ± 3,1 Nguyen nhan vo smh (%) Tac voi 25 40,6 43,3 38,1 Do chong 50 18,6 18,6 19,8 Khong ro nguyen nhan 0 33,4 35,7 30,4 Khac 25 7,4 7,6 6,5 Tong 100 100 100 100. Nhom 5 (>15) 498 30,9 ± 5,0 7,1 ± 3,8 38,1 21,7 32,3 7.9 100. P < 0,05«. <o,ffi;^. TAP CHi Y HOC VIET HAM TAP 459 • THANG 10 - S 0 1 - 2017. Thdi gian vo sinh trung binh So chu l<y IVF that bai trung binh. 2,3 ± 1,9. 6,2 ± 4,3. 5,3 ± 3,5. 4,9 ± 3,3. 4,6 ± 3,0. >0,05. 1±0 1781,3 ± 1099,5. 1,3 ± 0,8. 1,3 ± 0,8 2262,2 ± 807,5. 1,2 ± 0,6 1956,6 ± 714,4. 1,2 ± 0,6 1841,4 ± 589,7 6591,5 ±2912,4. >0,05. 2874,2 ± 829,3 0,05*** o n „ i „ hrr- ^,..„„ i,;„i, 1450,0 ± 2207,1 ± I 3470,2 ± I 4832,1 ± <0,05 E2 ngay hCG trung bmh j^ie.S 1444,0 I 1973:7 I 2613,8 *Tuoi trung binh nhom 1-5 noan i<hac biet co y nghTa thong ke (p <0,05) so vd ba nhom co > 5 noan. **AMH trung binh tang ro l<hi so noan tang (p < 0,05) trong cac nhom 2,3,4,5. * * * Tong iieu FSH trung binh cua cac nhom > 10 noan giam co y nghTa thong l^e so vdi nhdm 1-5 noan (p < 0.05). Nguyen nhan vo sinh, thdi gian vd sinh, so chu Ity IVF that bai khong khac biet giffa cac nhdm (khong ti'nh nhdm 1 vi n <5). E2 ngay hCG tang cd y nghTa thong ke khi so noan tang (p < 0,05). Bang 2. Kei gua noan va phdi thu du'dc cua nam nhdm noan khac nhau Nhom 2 Nhom 3 Nhom 4 Nhom 5 ( > P (6-10) (1-5) (11-15) 15) N 478 844 802 498 3,7 ± 1,2 <0,05 So noan thu du'dc trung binh 7,9 ± 1,4 12,9 ± 1,4 19,9 ± 5 . 5 84,5 84,0 >0,05 Ty ie thu tinh trung binh (%) 86,8 85,6 <0,05 So phoi trung binh 2,8 ± 1,3 5,7 ± 1,9 9,0 ± 2,7 13,0 ± 4,5 57,9 58,1 60,9 60,4 Ty ie phoi tot trung binh (%) >o,a5 3,2 ± 0,7 3,2 ± 1,1 <0,05" So phoi chuyen trung binh 2,5 ± 1,0 3,1 ± 0,6 2,5 ± 0,8 < 0,05"" 2,2 ± 1,0 2,4 ± 0,9 Sd phoi chuyen tdt trung binh 1,4 ± 1,1 Ty le thu tlnh, ty le phoi tot khong khac biet giu'a cac nhom. So phoi trung binh tang co y nghTa thong lie klil so noan tang. "So phoi chuyen trung binh va ""s6 phdi chuyen tot trung binh eua nhom 1-5 noan giam co y nghTa thong ke so vdi 3 nhom co s6 noan > 5. Tong iieu FSH trung binh. T y l e CO t h a i. Bieu do 1 . Ty 1^ co thai cf cac nhom noan. Ty le CO thai cao nhat 57% cf nhom eo 11-15 noan sau choc hiit, thap nhat cf nhom co 1-5 noan. Nhom CO 1-5 noan co ty le eo thai giam co y nghTa thong ke so vdi 3 nhom con lal^p < 0,001). Ba nhom CO so noan > 5 co by' le eo thai khac biet khong co y nghTa thong ke (p > 0,05). IV. BAN LUiOLN Ky thuat thu tinh trong ong nghiem la phu'dng phap dieu tri hiem muon hieu qua nhat hien nay. De dat du'dc hieu qua cao nhu' vay, viec kich thich buong trirng de thu dddc nhieu noan, chpn du'dc nhihig phoi t6t nhat de chuyen phoi da thanh thu'dng qui nham nang eao ty le thanh cong. Nhieu nghien cu'u tren the gidi da de cap den moi lien quan giiJa so lu'dng noan va ket qua thu tinh trong ong nghiem. Co nghien ciJTu tinh chiing ca ty le CO thai sau chuyen phoi tu'di va ty. le thai cpng don cho eac ehu ky chuyen phoi dong lanh ciia ehu ky tru'dc do phai dong phoi toan bo do qua kich buong triTng. Cd nghien CLTU ehi tinh rieng chuyen phoi tu'di. Nghien cii'u eiia Chung toi la mot trong so do.Tuy nhien, da so eae nghien cu'u tru'dc day chi de cap den ket qua thai ma bo sdt ket qua phoi, khac vdi nghien ciTu ciia chiing tdi.Ket qua nghien ciTu eiia chung toi chi ro vdi nhom co sd \ddng noan 1-5, vdi dac diem ed m l u ciia nhdm ed nhieu khac biet ve tudi cao, AMH thap, tong lieu FSH cao hdn, trong. VIETNAM MEDICAL JOURNAL N°1 - OCTOBER • 2017. khi SO lu'dng phoi, sd phdi chuyen, so phdi chuyen tdt giam rd ret dan den ket qua thai giam CO y nghTa thdng ke so vdi cac nhom nhieu noan hdn, do vay s6 noan toi du phai dat du'dc tir 5 noan trd len. Hdi khac vdi nghien ciTu ciia^ehiing toi, Jingjuan Ji va cpng su" (2013), cho rang sd noan tdi u'u tnang khoang 6-15, ty le ed thai nhdm 0-5 noan (n=381) la 34,1%, nhom 6-10 (n=965), nhdm 11-15 (n= 726) ciing la 41,1%, nhom > 15 (n=383) la 27,4% [4]. Tanya va edng sir (2006) cung cd ket qua tu'dng td [5]. Trai lai, nghien cii'u ciia Cai va cpng sir cho rang so noan khdng anh hu'dng den b/ le ed thai, tuy nhien tac gia ehi chpn vao nghien ciTu cac tru'dng hdp cd it nhat 2 phdi chuyen tdt [6]. Nghien ciTu ciia Gaast va cpng sir cho biet sd noan tdi du dat ty le cd thai tdt nhat la 13 noan [7]. t d m lai, ket qua nghien ciTu ciia ehiing tdi nhan thay so noan sau chpc hut neu ft hdn 6 noan se lam giam ty le cd thai, tren 15 noan ciJng khong lam tang t i ' le ed thai. Do vay so noan toi uti chung toi de xuat la 6-15 noan. V. K€Y LUAN So noan tdi uli sau chpc hut cho ket qua cd thai tot nhat la tuT 6-15 noan. Ldi cam dn: Chung tdi xin tran trpng cam dn Trung tam Ho trd sinh san Benh vien Phu san Trung U'dng va eac benh nhan da hd tn? tham gia nghien ciTu.. TAI UEU THAM KHAO 1. Inge GB, Brinsden PR, Elder KT, (2|3G "Oocyte number per live birth in IVF: w e r ^ ^ and Edwards less wasteful?" Hum mi 2005;20:588-592. 2. Hamoda H, Sunkara S, Khalaf Y, Braucie P EI-TouMiy T (2010). "Outcome of fresh IVF/ica cycles in relation to the number of cxiytK collected: a review of 4,701 treatment cycles" Hum Reprod 2010;25:i47. i. Zegers-Hochschild F et al. (2009], "International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the Wofld Health Organizabon (WHO) revised glossary of ^ terminology, 2009. ", Grossary of ART Terminology.. Vol.92, No.5, November 2009, 4. Jingjuan JI, Yusheng Liu, Xian Hong Tonget al, (2013). "The optimum number of oocytes in IVF treatment: an analysis of 2455 cycles in China". Human Reproduction, Voi.28, No.10 m. 2728-2734. 5. Tanya Timeva, Tanya Miladiidi, Irena Antamova et al, (2006). 'Ximelatton Between Number of Retrieved Oocytes and Pregnancy Rate After In Wo Ferblization/IntraCytoplasmic Spenn InfedJon". TTe i Sc^mc Wold JOURNAL (WOS) 6,6^-690. 6. Qianfang Cai, Fei Wan, Kai Huang, Hanwang Zhang (2013). "Does the Number of Oocytes Retrieved Influence Preanancy after Fresh Embryo Transfer'". PLoSOne. 2013; 8(2). 7. MH van der Gaast, MJC Eijkemans, IB van der Net et al, (2006). "Optimum number of oocytes for a successful first IVF treatment cyde". Reprodudive BioMedldne Online, Vol 13, Issue 1, Pages 476-480.. THirC TRANG BENH VIEM LffI MAN TINH TREN BENH NHAN DAI THAO DU'ffNG TAI BENH VIEN DONG DA, H A N 6 I NAM 2017 Le Long Nghia* T O M TAT Viem lcfi chiem ti le cao trong cpng dong, trong do nhij'ng ngUcJi mac dai thao du'dng c6 nguy cd mac viSm lcfi cao hcfn. Muc tieu: Mo ta thUc trang viem ldi man tinh tren benh nhan dai thao dUdng. boi tu'dng: nhOhg benh nhan duwc chan doan mSe benh dai "thao du'cfng ta'i benh vien Ddng Da Ma npi. Phu'dng phap: nghien cuTu mo ta cat ngang. Ket qua: Viem Ipi nang chiem ty le thap nhat la 5,1%. Viem ldi trung binh chifm tl le cao nhat la 44,9 %, theo sau do la viem ldi nhe chiem t/ le thap hdn la 24,5%. Ty le viem ldi d rid la 71,4% thap hdn 10,7% so vdi nam gidi. Ket luan:. *Vien Dao tao Rang ham mSt, Dai hoc YHa ngi Chiu trach nhiem chinh: Le Long Nghia Email: nghia.lelong@gmail.com Ngay nhan bai: 5.7.2017 Ngay phan bien khoa hoc: 30.8.2017 Ngay duyet bai: 8,9.2017. 132. Benh nhan dai thao du'dng mac viem ldi v6i ti le cao, ti le benh giam dan ti^ nhe tdi nang tdkhoa: dai thao dudng, viem l<^ SUMIVIARY STATUS OF CHRONIC GINGIVITIS IN PATIENTS W I T H DIABETES AT THE DONG DA HOSPITAL, HA NOI I N 2017 Gingivitis is high in the community, espeaally diabetic people have a higher risk of gingivitis. Aim To describe chronic gingivitis in diabetic patients. Subjects: Patients diagnosed wiOn diabetes at Dong Da Hospital, Hanoi. Method: cross-secbOM^ descriptive study. Results; Severe gingivitis accoums for the lowest rate of 5.1%. Average gingivitis accouniM for the highest rate of 44.9%,followedby mild glngpS which was 24.5%. The rate of gingivitis in women G 71.4% lower 10.7% than men. Condusion: PatoiB diagnosed diabetes mellihjs had gingivitis with a iiigi rate declining from mild to severe. Keywords: diabetes, gingivitis.